Document Type : Original Article
Authors
1 M.B.Ch.B, C.A.B.M.S (ortho), Senior Orthopedic Surgeon, Subspecialist knee-hip Reconstructive surgery, Basrah Teaching Hospital- Basrah, Iraq
2 M.B.Ch.B, F.I.C.M.S (ortho), Senior Orthopedic Surgeon, Al-Zahraa Medical College- Basrah, Iraq
3 M.B.Ch.B, F.I.C.M.S (ortho), Senior Orthopedic Surgeon, Subspecialist knee-hip Reconstructive surgery, Basrah Teaching Hospital- Basrah, Iraq
Abstract
Background: Fractures of the long bones in the lower limbs, such as the femur and tibia, are common injuries that typically result from high-energy trauma. These injuries often require surgical intervention, with techniques like Minimally Invasive Plate Osteosynthesis (MIPO) being favored due to their ability to minimize soft tissue damage while providing stable fixation. However, the success of fracture healing is influenced by various risk factors, including smoking, age, and body mass index (BMI), which can significantly impact the biological and mechanical processes essential for bone repair.
Objective: This study aims to assess the impact of various risk factors, including smoking, age, and body mass index (BMI), on the bone healing process in patients who underwent Minimally Invasive Plate Osteosynthesis fixation for extra-articular long bone fractures in the lower limbs.
Methods: A cross-sectional analysis was conducted at Basrah Teaching Hospital from June 2010 to June 2012, involving 76 patients aged 20-60 years. Patients with extra-articular comminuted fractures were treated using the Minimally Invasive Plate Osteosynthesis technique. Data on patient demographics, fracture characteristics, surgical details, and postoperative outcomes were collected and analyzed. Statistical significance was determined using appropriate tests, with a p-value of <0.05.
Results: The study found that smoking significantly delayed bone healing, with smokers showing slower healing times compared to non-smokers (p=0.0008). Younger patients (<30 years) demonstrated faster healing compared to older patients (p=0.041). Although BMI did not show a statistically significant impact on healing (p=0.716), trends indicated that underweight and normal-weight patients healed faster.
Conclusion: Smoking and age are significant factors influencing bone healing in patients undergoing Minimally invasive plate osteosynthesis fixation for lower limb fractures. While BMI did not significantly affect healing outcomes, the findings suggest that lifestyle factors play a crucial role in recovery after fracture fixation.
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Main Subjects
2. Sheen; JR, Mabrouk; A, Garla. VV. Fracture Healing Overview [Internet]. Treasure Island (FL): StatPearls; 2023 [updated 8 April 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551678/ .
3. Foster AL, Moriarty TF, Zalavras C, Morgenstern M, Jaiprakash A, et al. The influence of biomechanical stability on bone healing and fracture-related infection: the legacy of Stephan Perren. Injury. 2021;52(1):43-52. https://doi.org/10.1016/j.injury.2020.06.044
4. Gupta S, Teotia AK, Qayoom I, Shiekh PA, Andrabi SM, et al. Periosteum-Mimicking Tissue-Engineered Composite for Treating Periosteum Damage in Critical-Sized Bone Defects. Biomacromolecules. 2021;22(8):3237-50. https://doi.org/10.1021/acs.biomac.1c00319
5. Shim DW, Hong H, Cho KC, Kim SH, Lee JW, et al. Accelerated tibia fracture healing in traumatic brain injury in accordance with increased hematoma formation. BMC Musculoskelet Disord. 2022;23(1):1110. https://doi.org/10.1186/s12891-022-06063-5
6. Giordano V, Souza FS, Belangero WD, Pires RE. Limb Salvage after Lower-Leg Fracture and Popliteal Artery Transection-The Role of Vessel-First Strategy and Bone Fixation Using the Ilizarov External Fixator Device: A Case Report. Medicina (Kaunas). 2021;57(11).
https://doi.org/10.3390/medicina57111220
7. Zbeda RM, Friedel SP, Katchis SD, Weiner L. Open Reduction and Internal Fixation of Posterior Malleolus Fractures via a Posteromedial Approach. Orthopedics. 2020;43(3):e166-e70.
https://doi.org/10.3928/01477447-20200213-01
8. Saul D, Khosla S. Fracture Healing in the Setting of Endocrine Diseases, Aging, and Cellular Senescence. Endocr Rev. 2022;43(6):984-1002. https://doi.org/10.1210/endrev/bnac008
9. Augat P, Hollensteiner M, von Rüden C. The role of mechanical stimulation in the enhancement of bone healing. Injury. 2021;52 Suppl 2:S78-s83. https://doi.org/10.1016/j.injury.2020.10.009
10. Al-Mukhtar S. The Effect of Cigarette Smoking on Bone Healing in Elderly Individuals with Colle's Fracture. Tobacco Use Insights. 2010;3:17. https://doi.org/10.4137/TUI.S3009
11. Ehnert S, Aspera-Werz RH, Ihle C, Trost M, Zirn B, et al. Smoking Dependent Alterations in Bone Formation and Inflammation Represent Major Risk Factors for Complications Following Total Joint Arthroplasty. J Clin Med. 2019;8(3). https://doi.org/10.3390/jcm8030406
12. Emaus N, Wilsgaard T, Ahmed LA. Impacts of body mass index, physical activity, and smoking on femoral bone loss: the Tromsø study. J Bone Miner Res. 2014;29(9):2080-9.
https://doi.org/10.1002/jbmr.2232
13. Thorud JC, Mortensen S, Thorud JL, Shibuya N, Maldonado YM, et al. Effect of Obesity on Bone Healing After Foot and Ankle Long Bone Fractures. The Journal of Foot and Ankle Surgery. 2017;56(2):258-62. https://doi.org/10.1053/j.jfas.2016.11.010
14. Goodloe JB, Traven SA, Herzog LN, Richardson CM, Daley DN, et al. Elevated BMI is associated with intra-articular comminution, prolonged operative time, and postoperative complications in distal radius fractures. Injury. 2020;51(11):2612-6.
https://doi.org/10.1016/j.injury.2020.08.006
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